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Dickens and Neurology | Montreal Dickens Fellowship

Montreal Dickens Fellowship
for the best of times

Dickens and Neurology

By: Louise de Tonnancour

February 2021
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Our planet experienced great turbulences during 2020. World leaders had to turn to the science of medicine to more or less guide us through difficult moments. Researchers in the medical field were pressed by governments , pharmaceutical companies and universities to find a vaccine . It was urgent!

In view of this, I thought of shedding a little bit of light on the great accomplishments made by marvellous and inspired physicians, mostly in the 19th century, who sometimes worked alone, in small groups or within the walls of a hospital to relief or cure disorders of the body and the mind.

The 19th century was called Victorian because of Queen Victoria reigning almost through it. It was also called The Long Century, a term for the 125 years period from 1789 to the outbreak of WWI. It refers to the notion that reflects a progression of new ideas which are characteristic to an understanding of this century.

Physicians also benefited from the use of new or improved instruments and methods for treating patients. For instance:

-The mercury-in-glass or mercury thermometer was invented by physicist Gabriel Fahrenheit in Amsterdam in 1714. The Fahrenheit scale is still in use today.

-The stethoscope was invented in 1816 by a French physician named René Laennec. It was much more helpful than putting ear on the patient's chest to perceive sounds made by the heart and the lungs.

-The hypodermic needle and syringe was first used in 1853 by physician Alexander Wood in Edinborough to inject morphine into humans. He is credited for inventing the technique.

The syringes are found in Greek and Roman literature where there are descriptions of hollow reeds for the ritual of anointing the body with oil. They were also used as musical instruments. In 1659, Christopher Wren, better known as architect than for medical training, pioneered a syringe made of animal bladder fixed to a goose quill to inject wine and opium into the veins of a dog.

-In the 19th century, Louis Pasteur identified germs as the cause of many diseases around the world thanks to the advancement in microscope technique. He also advance the study of virology in medicine. He is best known to the general public for pasteurization, his invention to stop bacterial contamination.

-Vaccines were also introduced at the end of the 18th century by English physician and scientist Edward Jenner. He pioneered the first smallpox vaccine. The vaccine became mandatory and by 1980 the world was declared free of smallpox. In Dickens' "BLEAK HOUSE" Jo, Charley and Esther contracted smallpox.

-In 1895, German physicist Wilhelm Conrad Roentgen discovered x-rays which were first to be used by battlefield physicians to locate bullets in wounded soldiers.

Here, there and everywhere, and most certainly in the field of medicine, the world was moving towards an advance state of understanding. Also with research, neurology leapt towards new frontiers. Let me introduce you to three physicians very much involved in this course of action.

-Armand Duchenne de Boulogne. His studies evolved around muscular dystrophy. He also left us with the Duchenne smile, a smile that involves certain muscles and signals true happiness. The smile occurs when some muscles lift the corners of your mouth and other muscles, around your eyes, lift your cheeks and crinkle your eyes at the corner.

-Pierre Paul Broca best known for his research on Broca's area, a region of the frontal lobe named after him. He revealed that patients suffering from aphasia had lesions in a particular part of the cortex. This was the first anatomical localization of brain function. His work helped to develop anthropology and anthropometry.

-Jean Martin Charcot also a French neurologist best known for his work on hypnosis and hysteria. His name has been associated to various conditions sometimes referred to as the Charcot diseases.

Dickens first witnessed mesmerism or hypnosis, as we call it today, performed by physician John Elliotson who had learned the technique from Baron Jules Dupotet who arrived in London to advertise and demonstrate it.
Dupotet remained ignored by the public and the medical profession. Hypnosis had flourished on the continent but remained largely ignored in England until 1837.

Dickens asked John Elliotson to teach him. He immersed himself in books on the subject and went on to hypnotise his wife Catherine and his sister-in-law Georgina but never submitted to be hypnotise himself.

He even introduced mesmerism into his fiction. In Oliver Twist, he describes Oliver falling into a trance like state. In Nicholas Nickleby, Nicholas reads a book as if "in a magnetic slumber".

At the blacking factory where he worked at the age of twelve, after his father's imprisonment at the Marshalsea, Dickens encountered much despair and loneliness in a very hostile environment. This experience left an indelible impression on his psyche. All his life, he kept it a secret but it transpired through his novels, mainly in the true to life description of his characters. He was able to do so because he had witnessed poverty and diseases.

"Dickensian Diagnosis. " is the title of an article, I had the pleasure of reading, written in 1955 for a medical journal by Sir Russell Brain who was a physician to the London Hospital of Nervous Diseases. This hospital opened in 1867, closed in 1993 and was replaced by National Hospital for Neurology and Neurosurgery.

Here is a quotation by Sir Russell Brain: "Perhaps it is most surprising that disease should play a considerable part in the novels by Dickens. He took pleasure in portraying the bizarre, the grotesque and, indeed, the horrifying; and, when he lived, the visible effects were much more obvious than they are today. This is partly because the progress of medicine has fortunately eliminated many of it's grosser manifestations, and partly because in Dickens' days there were few facilities for the segregation of people seriously afflicted in body and mind. What is surprising however, is that he should have given such detailed and accurate descriptions of the disorders his characters suffered. He was not content with vague diagnosis like brain fever, which figure in the works of some of his contemporaries, and even those who wrote much later. Dickens looked on diseases with the observing eye of the expert clinician, and recorded what he saw and what the patient told him, so that he often gives us accounts which would do credit to a trained physician."

Now let's look at a few cases related to neurology disorders in Dickens's pages.

-Head injuries: with Eugene Wrayburn in "Our Mutual Friend" it's a clear description of fluctuating consciousness. With Mrs Gargery in "Great Expectations" he made a very good account of an aphasic person making incredible efforts to be understood.

-Cerebral arteriosclerosis: with Mrs Skewton in "Dombey and Son", Dickens gave us an accurate and quite long description of her trying to write. Loss of speech is associated with paralysis on the right side. This is why she couldn't write. She had agraphia. Sir Leicester Dedlock in "Bleak House" had a stroke and Dickens wrote... "his whispers sound like mere jumble jargon" an anticipation of the term jargon aphasia. Mr Dorrit in "Little Dorrit" also had some cerebral problem which seems to be vascular. One of his earliest symptom was narcolepsy. He fell asleep several times during a meal. Mr Willet in "Barnaby Rudge" shows symptoms of apoplexy resulting from a cerebral haemorrhage or a stroke.

-Symptomatic epilepsy: it struck Anthony Chuzzlewit in" Martin Chuzzlewit".

-Paraplegia: grand-father Smallweed in "Bleak House" is the most well known case. Here is how Dickens described him " a helpless condition as to his lower limbs, and nearly so as to his upper limbs, but his mind is unimpaired". Another case was Mrs Clennam in "Little Dorrit" who did not leave her room for twelve years.

-Psychiatric studies: Old Chuffey, Anthony's clerk in Martin Chuzzlewit was a case of senile dementia. But, strangely enough, old Chuffey was suddenly cured. For the good of the plot, he was able to reverse his state and gave evidence concerning Anthony Chuzzlewit's death. What I allow myself to name reverse dementia.

-Schizophrenia: Mr. F's aunt in Little Dorrit was an elderly schizophrenic.

-Chronic Hypomania: it was suggested with the man in "Nicholas Nickleby" who made advances to Mrs. Nickleby, with great happiness and excitement, over the garden wall. Multiple Personality: without a doubt, Dr. Manette in "A tale of two cities".

-Mental defectives: Barnaby Rudge in the novel by the same name. Also Maggy in "Little Dorrit". Little Dorrit said "She had a bad fever, sir, and she has never grown older since."

There are many more clinical cases in Dickens novels . With Joe the fat boy, we see a subject with sleep breathing disorder which is still called the Pickwickian syndrome or more recently hypoventilation syndrome. Another memorable character was Tiny Tim. It was suggested he had Pott's disease.

Here is a brief list of other conditions described by the author : tuberculosis, chronic bronchitis , asthma, restless leg syndrome, Parkinson's disease, chorea, Tourette's syndrome, complication due to alcohoolism.

Dickens himself suffered from asthma, so he knew what he was writing about when he described Major Bagstock who had a "...wheeze very like the cough of a horse".

" At a time when medicine itself was only just beginning to recognize the importance of physical signs, the characters, in Dickens' imagination are so real that they have recognisable diseases of body and mind, described with the accuracy and insight of great clinical observer." Sir Russell Brain.

The Montreal Neurological Institute and Hospital ( with 85 beds)also called the Montreal Neuro or just the Neuro originated from the sub-department of neurosurgery at the Royal Victoria Hospital in 1933 before it moved to its newly constructed building across University street. In 1934, Sir Edward Beatty, chancellor of McGill, declared the institute formally opened.

The Rockefeller Foundation provided funds to build and equip the laboratories of the institute and created an endowment of one million dollars in support of the department of neurology and neurosurgery. The clinical or hospital part of the institute was built through donations from private individuals. The Province of Québec and the city of Montréal agreed that they would be responsible for the hospital's yearly operation. His current director is Dr.Guy Rouleau.

Research in the science of neurology is also done at L'Université de Montréal .

I invite you to raise your glass and toast all the men and women of the 19th century whose lives and works were a catalyst for modern medicine.